“This chest X-ray (CXR) image [Figure 1] was obtained after placing a left internal jugular (IJ) central venous catheter (CVC). The CVC was inserted easily under ultrasound guidance using a modified Seldinger technique, with pressure transduction confirming venous placement. However, the CXR revealed that the catheter did not cross the midline and instead took an abnormal lateral course. It also did not follow the course of the aorta. A blood gas sample was then drawn from the catheter confirming venous placement. A CT scan was then performed and revealed that the CVC terminated in the pericardiophrenic vein [Figure 2]. This abnormal placement was likely due to an occluded left brachiocephalic vein in our patient, which prevented the CVC from crossing the midline [Figure 3].

Wallisch WJ, Jouryyeh B, Beshara M. Misplacement of a Left Internal Jugular Central Venous Catheter in the Pericardiophrenic Vein. Ann Card Anaesth. 2025 Mar 20. doi: 10.4103/aca.aca_205_24. Epub ahead of print. PMID: 40110921.